Latest / Style Points / Soft Skills with Jay Mesrobian

Transcript

Soft Skills with Jay Mesrobian · Style Points

0:09
anesthesia enthusiasts, and welcome to Style
0:12
Points. My guest today is Dr. Jay Mizrobian.
0:16
He trained in anesthesiology at the University
0:18
of Pennsylvania and completed a pediatric anesthesia
0:21
fellowship at the Children's Hospital of Philadelphia,
0:24
and he has practiced in academic, private, hospital
0:27
-employed, and national group settings for more
0:30
than 25 years. He served as national medical
0:33
director and chief clinical officer for Team
0:35
Health Anesthesiology. leading roughly 1500 clinicians
0:39
across 23 states. He's a past president of the
0:43
Wisconsin Society of Anesthesiologists, served
0:45
as treasurer of the ASA, and has served on the
0:48
boards of the ASA, the Anesthesia Quality Institute,
0:51
and the Anesthesia Patient Safety Foundation.
0:54
He holds a degree in philosophy from Princeton
0:56
and a physician executive MBA from Tennessee.
1:01
Jay, welcome to the show. It's great to be here.
1:04
Thanks for having me. It's a real honor and privilege
1:07
to have you. I'm glad that you stopped by after
1:10
your Grand Rounds talk, after you've already
1:11
been talking to people for close to an hour.
1:14
You caught me at a good time. It's a good time
1:16
to just keep me talking. So let's go. I'm excited.
1:19
That's good. I appreciate that. To start, I wanted
1:23
to ask a question that I've been asking all of
1:25
my guests for a long time, which is my who would
1:28
you take to dinner question. If you had the opportunity
1:31
to have dinner with anyone, could be somebody
1:33
from the past or even from fiction, who would
1:36
you have out to dinner and why? It's a tough
1:40
question. It's kind of like picking my favorite
1:42
child or favorite song. But I'm going to give
1:44
you one I thought about yesterday. As our plane
1:47
was landing in Cincinnati, Ben Franklin popped
1:49
into my head. And I thought about someone who
1:53
could probably have insight into but also amazement
1:57
at science. politics, journalism, a man of many
2:05
talents, and I would love getting his perspective
2:08
on what we're doing today and how we're doing
2:10
it. He's really interesting. He's a polymath,
2:15
as I recall, and he had so many different talents
2:19
across so many different fields, which I think
2:21
is something that seems like it's a lot more
2:24
rare today. I think there's something, though,
2:27
common to everything he did, which is he had
2:29
intense curiosity. He had the ability to listen
2:33
and develop consensus around ideas. He was an
2:38
amazing influencer around the development of
2:41
the Declaration. Probably our first effective
2:44
ambassador for his time in France. A scientist.
2:49
Before he did all that, he published a paper.
2:51
So he understands that confluence of Public thinking,
2:57
public opinion, but also how do you advance an
3:00
idea? Now, after you've given your grand rounds,
3:04
I already have some of the answers to the questions
3:07
that I was going to ask you. But for the rest
3:09
of my audience who didn't happen to be at grand
3:11
rounds, I'm going to cover some of the same ground
3:14
pretty briefly. Philosophy, that was your major.
3:20
Tell me about how that has served you. what your
3:25
take is on philosophy and medicine in general.
3:28
Yeah, I will. You know, when I decided to be
3:31
a philosophy major in college, that was many
3:33
decades ago. And I did it because I liked the
3:36
subject matter, I liked the way it made me think,
3:38
and I liked the way it held me accountable to
3:42
having an argument or a discussion that made
3:44
sense. How did it influence me? I don't think
3:48
I really appreciated it for the first couple
3:50
decades. When I really had to get into roles
3:55
where how I brought teams together successfully
3:59
or unsuccessfully, how I made decisions, often
4:04
in the face of evidence that may not have been
4:06
clear. When those type of deeper under the waterline
4:12
challenges started coming up, that's when I started
4:14
appreciating it. I would often get told in meetings,
4:18
man, you ask a lot of questions. You always want
4:21
to get... understand why ideas make sense. And
4:24
that's when I started, when people started giving
4:26
me that feedback, for better or worse, is when
4:29
I started appreciating that seed training that
4:33
was planted in college around assessing others'
4:36
ideas, do different points of view make sense
4:38
or not? And how do you ask more questions to
4:42
get more clarity? And ultimately, how do you
4:45
make sense of something and make a decision,
4:47
even though you may not have a final answer?
4:50
So it wasn't evident right away. I think it took
4:52
time to develop the experience to allow that
4:55
latent education to kind of bubble up. Did you
4:58
always want to do medicine? Like many of us,
5:02
to be perfectly honest, I went into medicine.
5:03
I had an older brother who was an anesthesiologist,
5:06
11 years older than I am. He didn't influence
5:08
decision for anesthesia. But so I had a little
5:11
bit of a role model in health care in general.
5:15
I was like many of us. I had very simple reasoning.
5:17
I wanted to help people. I thought it would be
5:19
challenging. And I liked the idea of doing it.
5:22
So I went into it with some very simple, basic
5:26
things. I really did not know I wanted to do
5:28
it until I was well into college. One thing that
5:31
I found interesting about looking through your
5:35
history was that you did a Peds Fellowship. Tell
5:39
me about what led you that direction. It was
5:42
just, you know, how you rotate different areas
5:44
in the operating room or outside the operating
5:46
room, and some of it's just, what's comfortable?
5:50
Do I like the people I'm working with? Do I like
5:52
interacting with parents? In our specialty, you
5:55
have people who avoid certain things like the
5:58
plague. They'll avoid pediatrics, avoid cardiac,
6:00
avoid OB. I wasn't very good at cardiac. That
6:04
was pretty much a no -brainer. I wasn't going
6:06
to go into B cardiac. But something about peds
6:08
resonated. I loved the teamwork in it. I loved
6:12
the intense focus on the patient. There was something
6:14
a little different about kids. So it was a natural
6:18
to just kind of make that decision. Is working
6:23
with children something that helped prepare you
6:27
for leading large groups of adults? I'm going
6:31
to tell you a funny story about that in retrospect
6:34
when we get to the end. But yes, that's a great
6:36
question I hadn't thought about, but I would
6:38
say yes, because Unlike adults, children are
6:43
not always telling you what they're thinking,
6:45
feeling, or how they're understanding what you
6:49
say to them. So how you present yourself, how
6:52
you develop a safe environment for them to kind
6:55
of relax, to understand what's going on without
6:59
pressing you, pressing them to do something creating
7:03
stress, is very much applicable to how you manage
7:07
teams of people. Now, having said that, I'll
7:10
tell you a story that just this last summer,
7:11
I had my first opportunity to coach an urban
7:14
little league team in Milwaukee of T -ballers.
7:19
Hands down the hardest management task I've ever
7:21
had in my life. So I do think there's something
7:25
in there about how do you relate to children
7:28
to gently get them to see what you're trying
7:31
to say, communicate what your idea is so that
7:35
they will do in general what you'd like them
7:37
to do. I had the opportunity to watch my wife
7:41
coach my five -year -old daughter's soccer team
7:44
last night from 7 p .m. to 8 p .m., which is
7:48
a terrible time to have soccer practice for five
7:51
-year -olds. And her struggle was apparent. It's
7:58
like herding cats. Even in the best of times.
8:02
She's a pediatrician. She knows how to manage
8:04
kids. But, boy, it was... hard to maintain their
8:08
focus. You know, same thing. I remember doing,
8:11
taking care of these kids and, you know, 90 degree
8:13
weather outside. And one point, one of them looked
8:16
at me and he got this lower lip out and he goes,
8:18
you're mean. And I thought to myself, oh yeah,
8:23
maybe I need to lighten up. But that, you know,
8:25
that's, that's, you asked, started this question
8:27
by, is this analogous to how you lead? Absolutely.
8:32
Because if someone, if you're coming across to
8:34
someone as autocratic, dictatorial, or mean you
8:39
have a problem and you need to adapt. You need
8:41
to adapt on the spot. So if you want the best
8:44
example of how is that applicable to leadership,
8:46
that's how. You have to be able to adapt with
8:49
kids. You need to be able to adapt with teams.
8:52
Children, I've found, have the distinct ability
8:54
to give direct feedback very well. Probably more
8:59
than your team. More than I'd like sometimes
9:02
as a father of three. I remember those days.
9:06
I get it. So you were recently on the ASA's podcast
9:12
Central Line. Yeah. And you were talking about,
9:14
I would imagine, some of the same things that
9:17
you talked to us in Grand Rounds about just now,
9:20
which is humanities in medicine. Can you give
9:24
sort of a synopsis of, not necessarily your whole
9:28
talk, but your philosophy when it comes to instilling
9:31
humanities in medicine? Yeah, I will. Let me
9:35
preface this by saying, what are we talking about
9:38
the humanities? We're talking about art, music.
9:43
But in my case, what I talked to you all about
9:45
this morning was really literature. So great
9:48
literature, novels, history, poetry, philosophy,
9:52
religion. The thesis I'm laying out for you based
9:56
on my own experience, but also increasingly on
9:59
neuroscience and leadership science. is that
10:04
the humanities have a historical connection to
10:09
our present -day challenges in leadership. And
10:12
that in healthcare, we still often select leaders
10:15
based on technical, financial, operational expertise,
10:19
which are all critically important. But ultimately,
10:23
what's going to help you succeed as a leader
10:25
are what I call soft skills that are really hard.
10:30
And those are the things such as resilience,
10:33
discernment, getting perspective, asking questions,
10:37
being able to understand the context of the situation
10:40
you're in, the capacity for deep reflection.
10:43
Those are the things that are going to really
10:46
drive your success as a leader. But we don't
10:49
train for those very much in health care. So
10:53
that's really what I talked about is how can
10:54
we make that connection between the humanities.
10:58
as a tool to help you develop those types of
11:02
soft, hard skills. And I think there is a role
11:05
for them as a complementary support for leader
11:08
development. Do you think there's enough emphasis
11:12
on this in selecting candidates for medical school?
11:17
I remember being part of an admissions committee,
11:19
and this was back when I was in the tail end
11:25
of medical school, actually. They asked me to
11:28
interview a few candidates. And one of the things
11:31
that I remember them saying was, we're trying
11:34
to get more than grades. We're looking for people
11:39
who have the capacity to be reflective, to be
11:44
thoughtful, that can interact with patients better.
11:47
Do you think there's enough emphasis on that?
11:49
Or are we pushing too hard towards people who
11:52
are good at taking multiple choice tests? Having
11:55
not been on an admissions committee for medical
11:57
school, I'll caution my comments, but with that,
12:00
okay, so I certainly don't sit in the seats of
12:02
those who do that work. I think there is a role
12:07
for it, but perhaps it's a little limited. Let
12:09
me explain what I mean. Yes, I would love candidates
12:14
who have the ability, regardless of what they
12:16
majored in in college, to pause before they speak,
12:20
to take time to reflect on the situation they're
12:24
in. to think about why am I studying this topic
12:27
as opposed to getting the grade? How will this
12:29
impact my thinking as a clinician? It's more
12:34
an affect. But I think in medical school, we've
12:37
kind of defaulted, and probably rightly so, to
12:40
two things. Empathy and kindness is kind of the
12:45
attributes you want to cultivate in students.
12:47
And those are very good things to cultivate,
12:49
but they're very different. than a broader executive
12:53
skill set, the things I mentioned a couple minutes
12:55
ago. You could argue that a medical student will
12:59
not have the capacity or the practical experience
13:01
to really talk about that type of deep skill
13:05
set. So I think in a way it's unfair to require
13:07
them to bring that. But I want to assess their
13:10
capacity to develop in that way. I think that's
13:13
very important. So I'd do it in a limited way.
13:16
I certainly wouldn't make it. probably as much
13:19
of a factor as it might be if I were selecting
13:21
them 30 years later to run a large enterprise.
13:25
I recall in medical school it being very competitive.
13:30
We were all trying to get the top grades, get
13:33
into the residency that we wanted to. It was
13:35
very stressful. And I think a lot of my colleagues
13:40
at the time, and I would guess that it's the
13:42
same now, sort of something to brush to the side.
13:51
How do we make the humanities more important?
13:55
How do we emphasize it without encroaching on
14:01
sort of the professional responsibilities that
14:05
one has in trying to get those top scores? It's
14:09
a really wonderful question. I would answer this
14:13
way. If you make it a mandatory course, which
14:18
you can do, that's fine. It gets more exposure.
14:24
Everyone has to take it. You develop more rigor
14:27
in the curriculum. That's great. But then it
14:31
becomes no different than immunology, biochemistry,
14:35
or anatomy. And so people will assess it based
14:40
on... How useful is this to me? Am I really going
14:43
to be using this or am I going to just put that
14:45
book back on the shelf and forget it when I'm
14:47
done? I think the goal of the humanities piece
14:51
of education is to drive lifelong learning and
14:55
appreciation. So, you know, as we discussed a
14:58
little this morning, not being a sitting in the
15:02
seat of those who develop medical curriculums,
15:04
I would still wonder whether the better approach
15:06
is. a more Socratic atmosphere where you're exposing
15:10
students to a different way of thinking, discussing.
15:14
I think critically important to success is sharing
15:18
ideas with your colleagues. How does this make
15:21
you feel, me feel? How might I, I hadn't thought
15:24
of that type of conflict I might come into based
15:27
on the reading you had us do. What I'd really
15:30
want is a successful outcome for that is they
15:33
say, you know what? I am going to keep this on
15:36
my burner. for my entire life. I'm going to come
15:39
back to reading. I think that's your outcome.
15:42
So I want to be real careful. However you frame
15:44
it up should be in a way that drives that outcome,
15:47
not we got you through the semester, you got
15:49
exposed to a little humanities, and you're done.
15:53
One of the things that you talked about this
15:55
morning that I thought was really interesting
15:57
was where you were made professional director
16:01
of your group, and then it ended up that the
16:05
role was dissolved 18 months later, I think you
16:07
said. You put your failure sort of front and
16:15
center of the talk, and I think that that sort
16:18
of vulnerability is really important. One of
16:21
the talks that I have been giving to medical
16:23
students for a long time that just sort of follows
16:26
me through undergrad, medical school, and residency
16:30
is called Mistakes I Have Made. It's an increasingly
16:37
long talk. What do you think the role is of vulnerability
16:43
and making connection with people and putting
16:48
your failures up front? I think it's important
16:52
in this type of discussion to be honest and share
16:55
your experiences about where you failed and why.
16:58
And I've failed later in life too. I remember
17:02
distinctly failing with a practice leader once
17:08
in one of my roles where I was probably being
17:12
a little too forceful with what we needed to
17:15
do at a broader level and not realizing the impact
17:17
on him. So I don't want to make it seem like
17:22
I just had one experience early in career and
17:24
everything was great, but I used that early experience
17:27
as a big miss. And I think about it almost every
17:32
day of what should I have asked? What should
17:36
have been defined more clearly? How would I have
17:40
gathered the right group around the table to
17:42
develop meaning and mission around this new position?
17:46
What would successful outcomes look like? What
17:50
are the areas we're all concerned about that
17:52
are ambiguous about this that we're still going
17:54
to have to work in? At the time I was offered
17:57
that position, four or five years into practice,
18:00
I had no experiment or experience -based context
18:05
to really succeed there. And I own that. But
18:10
I still think we do that a lot to clinical leaders
18:13
today. We still pick them because they show up
18:16
on time, get stuff done, colleagues like them,
18:19
good clinically. Well, let's see if they're good
18:22
for a leadership role. And as I said earlier,
18:25
It's a different skill set that you have to add
18:28
on to your subject matter expertise. Absolutely.
18:33
One of the previous guests on this show said
18:36
that the hardest part of leadership was knowing
18:39
when to step down or step back. And he really
18:43
struggled when there was unfinished business.
18:45
Is that something that resonates with you as
18:48
well? It does. You know, you always want to go
18:54
into a meeting or a decision -making process
18:56
or something with some sort of resolution because
19:00
that's how we are trained as physicians or other
19:03
clinical leaders. Get a decision, get the information,
19:07
make a decision, develop consensus. There is
19:13
no doubt in my mind that sometimes it's better
19:15
as a leader to perhaps not make a decision. If
19:20
you think there's more you need to learn, discern,
19:26
ask questions about, or get different perspectives.
19:29
A lot of times you have to make a decision based
19:31
on inadequate evidence or in an area you're uncomfortable.
19:36
Another way of framing an answer to what you
19:38
said is, as a leader, as physicians, we're always
19:42
taught to lean in. You're leaning into the clinical
19:44
care. It's different as a leader. There's leaning
19:48
in. They're sitting still where you let others
19:51
around you develop the idea and you kind of moderate.
19:55
There's also leaning back where you almost will
19:58
actively take yourself out of a decision making
20:00
process other than being there. So I think it's
20:03
really important to kind of decide ahead of time
20:06
which one of those characters you're bringing
20:07
forward on the stage. And if it's not working
20:11
to be able to adapt in a meeting or in a process
20:14
and change your role. That's the key role compared
20:18
to what you do in clinical work. Compared to
20:22
when you were a little bit earlier in your life
20:26
and your practice, over the past 10 to 20 years,
20:30
how has your thought process evolved or changed
20:34
when it comes to leadership and your philosophy
20:39
in general? A couple things evolved over the
20:45
years. One is try not to go in with any hard
20:49
assumptions. We always say listen a lot, gather
20:53
perspective. I think one of the prerequisites
20:56
to doing that is really going in with a clean
20:59
slate in your head and an open mind to listen
21:02
genuinely. So if you go in with preconceptions,
21:07
you've already turned off a lot of your ability
21:09
to gather perspective. And I think that's a detriment
21:12
that I've learned to try to manage effectively.
21:16
The other thing I learned was, and is your physical
21:20
affect and your physical presence can often influence
21:25
how people see you. So I got told during the
21:30
high days of Zoom, right after COVID, where people
21:34
were meeting all on Zoom, one of my team members,
21:36
we were in one -on -one conversation. She goes,
21:38
hey, I just want to tell you. We can tell when
21:41
you're upset on Zoom. Oh, really? And my face
21:44
just blanched. I went, oh, no, I thought I was
21:47
doing a pretty good job at this. But she goes,
21:49
no, we can tell when someone says something and
21:52
you kind of get a look, like you might look aside.
21:54
And I went, I need to manage that. Because the
21:57
minute people see that, you're not maintaining
21:59
some evidence of neutrality, being open, but
22:05
also holding people accountable. If you're inconsistent
22:08
on that, they don't know what to expect from
22:10
you. So those are two things I've learned, probably
22:13
that physical affect, but also really turn off
22:16
your brain before you go into a meeting if you're
22:18
really going to listen and get perspective. How
22:22
did you learn the skill of managing your own
22:26
emotions to that degree? I'm not sure I ever
22:30
really fully learned it. I think a lot of it
22:36
goes into your preparation before a meeting.
22:38
You know, you asked the last question, what did
22:40
I learn differently? When you get to that, I
22:44
learned to prepare myself better for a meeting.
22:46
So I think many of us are so equipped going Zoom
22:50
meeting to Zoom meeting to in -person meeting
22:51
to other meeting to phone call, you never really
22:54
pause to do that deeper level of thinking. Why
22:58
am I doing this? Why am I going to the next meeting?
23:02
What do we hope to achieve in this meeting? A
23:06
very good person gave me advice a while ago.
23:08
He said, there are only three reasons to call
23:09
a meeting. Education, decision -making, or relationship
23:14
building. So one check I put on myself, to your
23:18
point, what of those three are we trying to accomplish
23:21
at this meeting? And if we can't identify one
23:25
of those three, I would ask, why are we having
23:28
the meeting? What's the point? So I think the
23:32
third thing, how I adapted was, understand the
23:35
purpose of the conversation, the meeting, and
23:40
make sure everyone understands it. Since part
23:43
of your success is it's not just that I understand
23:45
it if I'm running the meeting, it's how does
23:47
everyone around the table understand what we're
23:49
accomplishing there and make that clear up front.
23:52
Do you miss the OR? I still work there. When
23:57
I was in my executive role with Team Health and
24:01
also Medical College of Wisconsin, I did not
24:04
work in the OR full time, but I still was able
24:06
to work there usually a day a week, two days
24:08
a week now. Wow. I did miss it. I missed it because
24:14
it was in a lot of ways an oasis of safety and
24:23
pleasure and actually in a lot of ways more certainty
24:27
than a day when you're not in the OR. So I did
24:30
miss it. I missed the camaraderie of the team,
24:33
and I missed that truly genuine bond we have
24:37
when a patient gets the look on their face that
24:40
says, I trust what you're doing with me. Right.
24:42
That's special. When residents are thinking about
24:47
what sort of career they imagine for themselves,
24:51
and they're thinking to themselves, you know,
24:55
maybe I've done a lot of leadership positions
24:57
in residency. I might want to aim towards a career
25:02
or in the executive role eventually. What advice
25:08
would you give them? What would you tell them?
25:12
I think it's very rare that residents come out
25:17
and say, aha, I have a path I'm going to go on
25:19
so that in 20 years I'm here or here or here.
25:24
You can lay the goal out, but how you get there.
25:27
It's going to largely be organic. It's going
25:29
to be based on your own interest, where you identify
25:31
your own strengths over time, and where opportunities
25:35
come up, which is a long way of saying be adaptable,
25:39
be flexible, and be open to opportunities you
25:42
may not have thought about. A couple personal
25:45
examples. Early in my career, I told the story
25:49
this morning or last night to the residents about
25:51
my boss telling me post -call, I want you to
25:54
go down to the statehouse. I was post -call.
25:58
I was, you know, 34 years old. I'm like, Chris,
26:00
do I really? Yeah, I want you to go. I want you
26:02
to spend the morning there with our director
26:05
of South Carolina Society of Anesthesiologists.
26:09
That was the launching point to getting involved
26:13
in eventually the State Society, Wisconsin Society,
26:17
ASA. And those relationships and experiences
26:21
shaped my career in ways I never would have imagined
26:24
that day he asked me to go down to the Statehouse.
26:26
If I hadn't have done it, I would have closed
26:29
off a remarkable opportunity. So I think try
26:33
to be open to doing things that are outside as
26:37
a resident or a young attending your immediate
26:40
responsibility sphere. Try to do something new
26:44
every year. Do one thing that's not in that job
26:48
description. And that's how you're going to grow
26:51
and also start to learn. What really gets me
26:55
excited about health care in general? And what
26:58
might I be pretty good at that I can work on?
27:02
One of the things that I have noticed about myself
27:06
and some of my own leadership development, I'm
27:09
one of the associate program directors here,
27:11
is that I switch modes sometimes between being
27:17
a clinician and interacting with... The patients
27:22
and trainees and operating room staff. But when
27:25
I have to step back and act in a different role
27:27
as a leader, I have to change my mindset a little
27:33
bit. And you've done that to a much more advanced
27:38
degree, I would say. Can you talk about what
27:41
that frame shift looks like and how you put yourself
27:44
in one mindset or the other? Yeah, and I'm going
27:48
to. answer it in the sense of I've also, as I
27:51
said earlier, failed in that later in my career.
27:54
I think there are a couple things to make that
27:57
shift as successful as it can be. One is when
28:02
you're entering into a new circumstance, maybe
28:06
a new meeting, a new topic, a new group of people
28:09
you never met with before, there has to be an
28:12
example where you slow down Why is this taking
28:18
place? What is going to be my role here? Do I
28:21
understand the other people coming to this enterprise,
28:24
this initiative, this meeting, whatever? What
28:27
are their perspectives? If I don't know them,
28:29
how am I going to understand them better? So
28:32
there's a pause button you really need to hit
28:35
where you're asking yourself those questions
28:37
so that you can be an effective contributor.
28:43
or co -leader in a group like that so i think
28:45
that pause is number one number two is try not
28:50
to go into a meeting uh when you have to make
28:54
that transition if you're not in a good emotional
28:56
state try to get yourself in a state where you're
29:01
open you're listening you're you're engaging
29:05
with the right posture and you're making people
29:09
feel comfortable, talk to you, because people
29:11
will see it. If you come into a meeting and you
29:13
look rushed, upset, may have nothing to do with
29:16
what's going on at that moment, they'll get quiet,
29:19
and you won't hear what you need to hear. So
29:22
those are two things I would do to make that
29:23
transition. One thing that I've seen that you've
29:28
asked before is whether we should be teaching
29:30
operating room management as aggressively as
29:33
we teach airway management. One of those things
29:38
is something that we really focus on in residency.
29:44
We really want to make sure that our residents
29:46
can manage those challenging areas. Talk to me
29:49
about why operating room management is so important.
29:52
Sure. And I want to be clear when I say that,
29:56
I'm not saying teach it to the detriment of airway
29:58
management. Airway management is still core to
30:01
what we do clinically. There are three reasons
30:04
I would say. I believe that, and I believe it
30:08
very deeply. One is there is no one better equipped
30:12
to take on this role than an anesthesiologist.
30:16
We're the only people who see the entire perioperative
30:19
enterprise who are involved in it clinically
30:22
and operationally. Second reason is this is an
30:29
area of critical importance to our partners in
30:33
the healthcare system. It's incredibly important
30:37
to have an operating room that is efficient.
30:40
And being blunt, you don't want to waste time
30:43
or money. You want to make patients feel satisfied
30:47
and have a good experience coming through the
30:49
system well. You don't want to incur costs you
30:54
could have avoided. It's a critically important
30:57
role. And the third reason is so that anesthesiologists
31:02
really gain the stature, and the position to
31:06
which they can influence the success of both
31:11
the practice and the system, I see it as a huge
31:13
opportunity for alignment between anesthesiologists
31:16
and hospital systems. With the caveat it's one
31:19
that can begin a lot of hard conversations, and
31:22
there are a lot of stakeholders involved. But
31:26
it gets back to the philosophy, if we don't do
31:28
it, if we don't see the value in it, If we only
31:32
really focus on our time in the operating room
31:34
in the immediate pre - and post -op period, what
31:38
are we really bringing to the enterprise? What
31:40
value are we bringing that someone else could
31:42
probably bring, or at least in a partial way?
31:45
So I would say there's a strategic imperative,
31:49
there's a relational imperative, and there's
31:52
a what -do -anesthesiologists -do imperative.
31:56
It covers all three. When you're thinking about
32:00
leadership, do you see it as more nature or nurture?
32:05
Is it something that can be developed from scratch
32:08
or is it something that people have more inborn
32:12
and then just sort of develop along the edges
32:15
of? Boy, that's a really, really good question.
32:20
And if I rephrased it, I would say, can anyone
32:22
develop into an effective leader? That is a shorter
32:25
and perhaps better way to ask the question. I
32:30
love it. I think it's both. I do think there
32:36
are some inherent skills that can be built upon
32:42
slowing down, reading, reflecting, thinking,
32:46
being comfortable, getting perspective as opposed
32:50
to jumping to conclusion or trying to be quick.
32:53
Some of those are attributes some are born with
32:56
more than others. Now, having said that. When
32:59
I think back to initial leadership development,
33:01
it was modeling for me. I still remember the
33:04
three or four people who I first said, wow, they
33:07
have something different. They really understand
33:13
how to really make everyone in the room think
33:16
they're having a one -on -one conversation with
33:18
him or her when they're really not. So I think
33:23
about modeling as a critical role in that. But
33:26
I believe it is something that can be nurtured,
33:28
to your point. It can be taught. It can be learned.
33:33
It doesn't mean you won't skin your knees someday
33:35
again. But everyone, I think, with rare exception,
33:39
can develop the skill set to some degree. So
33:42
I think there's a lot of nurture. When somebody
33:47
is thought of as a great anesthesiologist, it's
33:51
not necessarily, in my experience, the same.
33:54
as being a great leader, although one can certainly
33:59
be both. What do you think is the difference
34:03
between somebody who is more of a great anesthesiologist
34:08
versus somebody who is more of a great leader?
34:14
There's a lot of overlap between the two if we're
34:18
willing to accept it and do it. I can be a great
34:22
anesthesiologist. clinically, by myself, in a
34:30
room, taking care of patients. I absolutely can
34:35
be a great anesthesiologist. I can be effective,
34:38
kind, efficient, clinically excellent. And at
34:43
the end of the day, I say, I got all my patients
34:45
through well. That's leading yourself. The next
34:51
step is how do you lead others? How do you bring
34:54
others along to see your vision? So part of the
34:58
challenge, and you hear a lot of anesthesiologists
35:00
say, and I'm sure I bet you nurse anesthetists
35:02
too, it's easier to work by myself than with
35:06
a team. You hear it a lot. I have heard that.
35:09
And it kind of is because you're only accountable
35:12
to yourself. There's no imperative to help others
35:16
understand decision -making, shared decision
35:18
-making, making sure perspectives are understood
35:21
on each side. the additional communication that
35:24
has to go into that process. So in a lot of ways,
35:29
working in a team, getting more perspective is
35:32
just, it's more work. But as a leader, that's
35:36
how you really drive things forward. If I'm just
35:39
working by myself, how much am I going to really
35:42
push forward beyond the immediate clinical care
35:44
I'm giving? Very little. So if we're going to
35:49
be leaders in the health system, leaders in our
35:51
practices, leaders with patients, it's going
35:54
to require working with others in the ways we've
35:57
talked about. That's, I think, the main difference
35:59
I would put out at either end of the bell curve,
36:02
so to speak. I want to pick your brain a little
36:06
bit about developing leaders and the role of
36:11
mentorship versus the role of coaching. Do you
36:15
see... There being a big difference between mentorship
36:19
and what the new buzzword seems to be is coaching.
36:23
What do you think? I would give this initial
36:27
response, and I may be offbeat here. I may be
36:30
misstating it. Mentorship to me is a little more
36:33
of an informal process. That story I told last
36:38
night to the residents about one of the first
36:39
mistakes I made in practice. And the head of
36:43
my group, who still I regard as a huge mentor,
36:45
Dr. Chris Yackel, he didn't berate me. He took
36:49
me out for beer and wings. And we talked about
36:53
why I wrote the note I did and the email in this
36:56
case. That's mentoring to me. It's modeling.
37:00
It's guiding. It's not informing. Coaching to
37:04
me is a little more formal. It involves taking
37:06
a specific situation you're in that may be ongoing.
37:10
Maybe you're having challenges with a dyad partner
37:13
in your leadership role. Maybe you're having
37:15
trouble getting your team to really respond to
37:18
you. It's a little more focused on taking an
37:21
ad hoc problem or an ongoing problem and how
37:25
are you addressing it in a way that creates better
37:28
results for you in your role. So that's how I
37:31
see the difference. I see the coaching a little
37:32
more prescribed and the mentoring a little more
37:36
ad hoc or organic. One of the experiences that
37:42
you've had that I haven't gotten to talk to very
37:45
many people about is leading very large groups
37:47
of people. Is it correct to say that you've led
37:50
about 1 ,500 clinicians across 23 states? Well,
37:54
it is, but I would say leadership is a multi
37:58
-level thing. Yes. If I could expand. So I'm
38:03
chief clinical officer for anesthesiology for
38:05
Team Health. And yes, there are 15 or so clinicians
38:08
in the clinician cohort of the company and the
38:11
practice. But the leaders are multiple levels.
38:15
There are other physician leaders regionally.
38:17
There are, most importantly, the leaders of the
38:19
practices on the ground. You know, what you would
38:22
call the chief of the department or the president
38:24
of the group. So when we say I've led 1 ,500
38:27
people, what it means is I'm trying to enable
38:30
them and those who are also leading, the regional
38:33
managers and the practice leaders, do they have
38:36
the tools, the resources, the information for
38:39
them to actually lead the group successfully?
38:42
So when I say lead, I want to be real clear.
38:44
It's not to tell them what to do, not to manage
38:48
their practice. It's to ask them, what do you
38:51
need? Can we provide it for you? and have a shared
38:54
vision of success. It's exactly that thing we
38:57
talked about earlier about stepping back a little
38:59
bit and trying to hear what they need and supporting
39:04
them, not jumping in to do it for them. One thing
39:09
that I've noticed about my colleagues and myself,
39:13
to be honest, in anesthesia, is that we all have
39:17
very strong opinions about the ways that leadership
39:23
has maybe not done the best job. It's a common
39:30
refrain that something should have been done
39:34
differently. And that's something that's discussed
39:37
in physician lounges, I think probably everywhere.
39:41
How do you think about that when you're thinking
39:45
about leading such a large group of people who
39:49
are very intelligent and who also have an element
39:52
of rugged individualism to them. You know, one
39:56
of my physicians, practice leader at Team Health,
40:00
said something to me that stuck a number of years
40:02
ago. He said, you know, we're all trained to
40:05
be master builders. We all think of ourselves
40:09
as master builders. So my way of kind of my vision
40:14
is right. I think when you're leading a large
40:17
cohort of people, One size does not fit all.
40:22
So there's a balance between each practice being
40:26
a master builder. And there are differences between,
40:29
you know, a four -clinician practice in rural
40:32
Ohio versus a large urban practice in Florida
40:35
with 100 clinicians. They have different needs,
40:38
different imperatives, different relationships
40:40
with their clinicians and with their hospital.
40:43
Yet at the same time, there are some things you
40:46
want to make sure are aligned. And that's around
40:49
how are we defining quality of care? Do we agree
40:54
that operational excellence is something we're
40:57
hanging our hat on? Do we believe that patient
41:00
experience in anesthesiology is an actual thing
41:05
that is important and valuable to what we do
41:08
as opposed to an add -on or a luxury? And do
41:12
we believe that leadership at the ground level
41:15
and maintaining relationships with your coworkers,
41:19
perioperative staff, and hospital leadership
41:21
is a critical aspect to what we do. So when you're
41:24
talking about leading large, diverse groups,
41:27
I think you have to align on principles and what
41:31
you define as success, but at the same time,
41:34
that will look different in those two different
41:36
types of practice settings. They will not do
41:40
the exact same thing, but they will have, in
41:42
a lot of ways, goals strategically. I think that
41:48
makes a lot of sense. Let me ask you a little
41:53
bit about our specialty in general and where
41:57
you think things are heading. Do you think that
42:00
anesthesiologists are positioned well to be leaders
42:07
in the operating room? Do you think that there
42:11
are areas of vulnerability that we need to address?
42:14
Based on your more national, zoomed -out perspective,
42:19
I wonder where you think things are headed. I
42:23
think we're in a great position for success.
42:26
As I said earlier, I think we have enormous value
42:29
in the perioperative space, and most people recognize
42:32
this. clinical initiatives that are truly groundbreaking.
42:36
It started with the perioperative surgical home,
42:39
which has morphed into perioperative medicine.
42:42
We have become gradually experts around operations
42:46
as well as clinical outcomes. I think we've developed,
42:50
both at the societal level and individually,
42:53
an increasing ability to step into leadership
42:56
roles, and you see more anesthesiologists doing
42:59
that. So I think we have enormous opportunity.
43:03
to drive not just what our practice looks like
43:06
in coming years but what health care looks like
43:09
how it's delivered and address the larger questions
43:13
around technology workforce etc the one caveat
43:17
i would put in is that it's really easy to get
43:21
caught listening to your own bubble sphere and
43:26
think you're going to bring solutions to the
43:30
systems the market without really understanding
43:33
how they're seeing their needs. What do I mean
43:37
by that? I'll tell a story, if I may. Please.
43:40
I was in a meeting a couple years ago with some
43:43
other fellow leaders at a societal level, and
43:48
one of them made the comment, I don't really
43:51
care what a hospital CFO thinks. All we have
43:55
to do is give quality. And I cringed when I heard
43:57
that. Because to me, that's the essence of I'm
44:01
not going to listen to what our partners or our
44:03
patients or our hospital executives are saying
44:07
they need an anesthesia. We're just going to
44:09
tell them what they need. That's how you take
44:13
all the expertise we've developed and throw it
44:16
in the water. So you have to listen effectively
44:20
to the market. You adapt when you can. You don't
44:23
when you think it's unsafe. And that's getting
44:25
back to it. There's your leadership challenge.
44:28
How do I know what my values are? How do I know
44:31
when I need to step up and apply them and speak
44:34
to them? But to simply discard people with whom
44:40
we work and say, I don't need to listen to them,
44:42
that's where we could get in trouble. If we get
44:45
that kind of intellectual ego, we'll be in trouble.
44:51
You've done some work in Milwaukee with startups.
44:55
Can you talk to me about that? Oh, you mean in
44:58
terms of practices? I think you did some mentoring
45:03
in the I -Corps program. Oh, gosh, that was fun.
45:07
Yeah, and that's actually a model in a lot of
45:09
ways, I think, for how anesthesiologists can
45:12
develop new sources of revenue, perhaps. So the
45:17
I -Corps program is a standardized program, mostly
45:19
at the undergraduate university level. It's a
45:23
regional national organization that... allows
45:26
professors and their students to bring ideas
45:31
to be evaluated. It's a rigorous process. So
45:35
in my case, I was advising a professor who was
45:39
developing a new type of anchor for tunnel and
45:44
parking garage ceilings because these fail. And
45:47
I'm thinking, I have no expertise in engineering.
45:51
They said, that's not the point. The point is
45:53
for you to make sure they're asking the right
45:55
questions. They go through. So the I -Corps process
45:57
is it's six weeks and it's very intense. It's
46:00
present your project. What do you think? You
46:03
get feedback from a number of people in the advisory
46:06
group, which I was on about who do you need to
46:09
go talk to in the community? You need to go talk
46:11
to. the construction firms you need to go talk
46:14
to the inspectors you need to go talk to the
46:16
state regulators you need to go talk to the building
46:19
architects which they did in six weeks they probably
46:22
talked to 40 people and got feedback all designed
46:26
to help you hone and make a better presentation
46:31
of your idea it's a remarkably efficient process
46:35
it works I was talking where I did this at University
46:39
of Wisconsin -Milwaukee of how many hits have
46:41
you actually had? She said, over 20 years. Very
46:45
successful because it helps them get from concept
46:49
to effective product presentation and really
46:53
hone in what's the purpose and who are the stakeholders.
46:56
Certainly a process that might have application
46:58
to what we do. Again, when we think about we
47:00
have a great idea to bring to the market in anesthesia.
47:04
We have a perioperative medical home. Great.
47:08
Do we know who wants it? Do we know what cost?
47:11
Do we know what trade -offs they're willing to
47:13
make? What about other competitors in the market
47:16
who are already doing this? Those are the key
47:19
questions asked. So the beauty of the I -Corps
47:21
process was it's not just about your idea. It's
47:24
about all those other things that go in that
47:27
will drive the success of it, which I found was
47:29
a fascinating experience. I'd love to do it again.
47:32
That's really interesting to hear about. Get
47:35
involved with that. One of the friends, one of
47:41
my main hobbies is I cycle. One of the guys in
47:44
my cycling group was the head of the University
47:46
of Wisconsin -Milwaukee Center for Innovation.
47:48
He was an engineer by training who had been in
47:51
this role 10 years, and he kind of oversaw this
47:53
process. So he said, hey, why don't you come
47:57
and just be an advisor on this, which I, it's
48:00
a wonderful experience. It gave me a fresh perspective
48:03
on what. what developing success looks like.
48:10
When I was doing a little bit of research on
48:12
you, one of the things that I saw is where you
48:15
described seeing Eric Clapton. And one of the
48:19
things that stuck with you wasn't necessarily
48:22
him playing, but the other musicians stopping
48:25
to watch out of respect. I wonder if you could
48:27
expand on that story a little bit and tell me
48:30
why that stuck with you. Other than my desire
48:34
to have some level of expertise that even approaches
48:36
Eric Clapton? Yeah, that would be great. It was
48:41
something very evident. Remember I talked earlier
48:43
about the mentoring aspect and the modeling,
48:46
and when you see someone who knows when to step
48:49
forward, step back, listens with purpose, you
48:53
go, huh, I see that. There's something there.
48:57
You want to model that. When I saw him on stage
49:02
a couple years ago, and when he would, you know,
49:05
he was, I told this in the story, he was older,
49:08
his voice was a little shot, but he could still
49:11
play the guitar. And when he did those half dozen
49:14
Clapton -esque things that only he can really
49:17
do in a concert, you saw the other people, the
49:20
keyboardists, the other guitarists, everyone
49:22
was looking at him. And the sense I got was it
49:25
wasn't just, well, we're waiting for the cue
49:27
as to when he's going to finish the solo. It
49:30
was really like, what's he doing? How's he doing
49:33
this? You could see it in their faces. It was
49:37
really different. Because they've rehearsed.
49:39
They know when he's going to end the solo. But
49:43
they're watching him because of what he's doing.
49:46
That's, to me, modeling at its best. You're just
49:49
presenting something aspirational and making
49:51
them feel better about the overall thing you're
49:55
developing. I gave an example this morning of
49:58
the Duke Ellington autobiography, where he interviews
50:02
himself. It's called Music is My Mistress. And
50:06
it's a funny way he writes it, but he basically
50:08
says, well, how do you make sure the whole band
50:10
is inspired together, not fighting? He said,
50:14
I make sure everyone understands their role.
50:16
I make sure they know their role matters. I make
50:18
sure they know that they're building something
50:20
better than their individual parts. And then
50:24
he says, of course, you have to manage them too
50:26
if they show up late. That part about starting
50:30
with, what are you doing? Why does it matter?
50:33
Why does it matter for the larger success of
50:36
what we're trying to do here? And now I go, aha,
50:39
now I'm going to blend in as part of the larger
50:42
big and know that my part contributes. So I think
50:46
I saw that reaction on stage with Clapton, and
50:49
I read about it in Ellington's autobiography,
50:52
how he managed a very large band so successfully
50:55
for decades. The last question that I typically
51:01
ask people is a question about what your style
51:06
points are. And I'm going to ask you the same
51:08
question, but I also want to point out that I
51:10
feel like our entire conversation has been a
51:13
series of asking you that in different ways.
51:16
But if you were to pick out something that you
51:22
would say is one of your main style points, things
51:26
that are one of your personal preferences, the
51:28
way that you interact with people, the way that
51:29
you lead, what would be that quintessential piece
51:34
of advice that you would give? For me personally,
51:40
the one that bubbles up when you ask that question
51:43
is patience and hear people out. The one thing
51:48
that will get my goat in a meeting is when people
51:51
interrupt each other. Now, occasionally you have
51:54
to, if someone's really, really going on, you
51:56
have to say, hey, let's take a break and maybe
51:58
invite another perspective. But I really respect
52:02
listening to someone articulate the full thought,
52:05
not letting them or me interrupt them or vice
52:09
versa, so that you really are gathering perspective
52:13
in all its fullness. I think that is absolutely
52:16
critical part. So that patience you have to have
52:20
to listen through. If there's an opportunity
52:22
to ask a follow -up question that helps get the
52:25
idea out better, you should do it. But I think
52:28
that's a critical thing in terms of a personal
52:31
style point that I really want to see happen.
52:35
Jay, thank you so much for joining us. This was
52:38
enormous fun today. Thanks for having me. I hope
52:40
it's helpful and I appreciate it. That's it for
52:45
this episode of Style Points. My thanks to Dr.
52:48
Mizrobian for sticking around after grand rounds
52:50
and giving us so much of his time. Since he made
52:53
the case for reading his leadership training,
52:55
I'll add a recommendation of my own, An Astronaut's
52:59
Guide to Life on Earth by Chris Hadfield. I've
53:02
been recommending it to anesthesia applicants
53:03
for years, and it's as good a book on preparation,
53:06
humility, and learning from your mistakes as
53:09
I know of. If you got something out of this episode,
53:12
the single best thing you could do to help other
53:14
people find the show is to leave a rating or
53:17
written review. You can always reach me at stylepointspodcast
53:20
at gmail .com. Take a deep breath. Open your
53:25
eyes. We're all done.